Hospital lied over wait lists

By Julia Medew and Nick Miller

March 31, 2009 — 12.00am

THE Royal Women's Hospital has been systematically lying about its surgery waiting list for almost a decade, says a damning report that has forced the Government to overhaul Victoria's hospital funding system.

Health Minister Daniel Andrews yesterday apologised to patients who waited months longer for surgery than the Women's has claimed since the late 1990s. He said an independent audit — commissioned after The Age earlier this month revealed the hospital had incorrectly reported data to the Government — confirmed the creation of a "second waiting list" that was disguising the hospital's real performance.

About 180 patients waiting for semi-urgent surgery every year waited an average of 95 days longer than the hospital was reporting, the audit found. This occurred in the context of inadequate scrutiny at the executive level.

The finding comes after The Age revealed allegations last May that hospitals were manipulating data to meet benchmarks for bonus funding. Mr Andrews consistently denied the practice was taking place and refused to investigate.

In response to the audit's finding, Mr Andrews yesterday announced that:

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?A long-standing $40 million bonus funding pool used to reward hospital performance would be scrapped.

?Six hospitals would be audited without warning every year.

?Patients would be notified in writing if their waiting-list status changed, so they could challenge any discrepancies.

Mr Andrews said he was furious about the audit results and put all Victorian hospital boards on notice that data manipulation was unacceptable.

"Health services are accountable for their data and there is an expectation that they record and report it accurately," he said.

The audit of the Royal Women's Hospital found that although staff spoke of "two waiting lists" in front of senior and executive management, executives claimed they knew nothing of it.

A "data-entry instruction sheet" revealed that when patients neared a benchmark for how long they should wait, they were put on a secret list, which effectively stopped the clock.

The Government rewards most hospitals with bonus funding if they meet performance benchmarks, but the Royal Women's is not on this list. Mr Andrews said it had previously been on the list and that data manipulation appeared to be a long-standing practice potentially motivated by the incentives.

He said he had appointed a delegate to the board of the Royal Women's to ensure the fraud was eliminated. The secretary of the Department of Human Services had received the report and would take legal advice on what action could be taken against those involved, he said.

Royal Women's chief executive Dale Fisher said she had ordered a clinical review to establish whether patient care was affected by the list rorting.

She said that, "on the face of it", there was no effect on patients because the list manipulation did not change the booking date of an operation, only the report of the patient's waiting time. "The people got treated at the next available opportunity," she said.

But Ms Fisher admitted it might have hurt the hospital's gynaecological department.

"That's one of the disappointing things … that it did compromise our view of demand in gynaecology," she said. "We could have strategically allocated more resources."

She said "appropriate disciplinary action" would be taken against staff involved in the practice. This could range from counselling to sacking — but no one had yet lost their job.

Ms Fisher defended her management of the hospital, saying there was no reason the executive team would have spotted the practice, because it was designed to "iron out" the kinds of peaks and troughs that drew management attention.

"I am pleased that we found the problem and fixed the problem," she said. But Ms Fisher said she may never have realised the seriousness of the issue if it was not for a report in The Age this month about waiting-list fraud in unnamed hospitals — a month after she knew about the list problem at her own hospital. "When I found this … I viewed it as a management problem that we needed to fix. The level of seriousness was raised as a result of that article … It was the issue of possible fraud (that) raised the level of seriousness."

The hospital will centralise training of staff to get greater control over data reporting, and its internal auditors have been asked "to make sure we're not missing anything else".

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The Victorian president of the Australian Medical Association, Doug Travis, welcomed the decision to scrap the bonus pool, saying it would allow hospitals to focus on patient care. "There has been a culture in Victorian hospitals to hit your (key performance indicators) no matter what," he said. "Our community needs to be assured that hospital funds and resources are directed where they are needed."

Shadow health minister Helen Shardey said the Government's response was inadequate because six random audits a year would allow a major hospital to go three years without being audited. "There should be an immediate independent audit of all hospital waiting lists," she said.